It’s Time We Talk About Endometriosis

Endometriosis—when the uterine lining grows outside of the uterus, resulting in severe pain, swelling and bleeding—is thought to affect more than 11 percent of all American women between the ages of 15 and 44. This condition impacts 6.5 million U.S. women, and 176 million women worldwide. Yet, it is still not easily recognized. It takes about 10 years from when women experience their first symptoms to receive an endometriosis diagnosis—half that time to recognize and bring up symptoms to a doctor and the other half for the doctor to diagnose it. For Endometriosis Awareness Month this March, we as obstetrician-gynecologists must do our part to raise awareness about the condition with our patients, strive to improve our understanding of the disease, and ensure more timely and accurate diagnoses.

Improving awareness and timely diagnosis of endometriosis helps women avoid unnecessary pain, and decrease infertility rates. Around 40 percent of all women with infertility have endometriosis and, of women diagnosed with endometriosis, about 40 percent experience fertility challenges. Many women struggling with infertility remain undiagnosed; others won’t be diagnosed with endometriosis until they start to experience problems conceiving. It falls to ob-gyns to reverse this trend, particularly as 63 percent of general practitioners feel uncomfortable diagnosing and treating patients with endometriosis, and as many as half are unfamiliar with the three main symptoms of the disease.

Early endometriosis diagnosis and treatment lead to better outcomes. Careful listening and discussion are integral to early detection, as many common symptoms are not so obvious, such as chronic lower back pain and intestinal problems like diarrhea, constipation, bloating and nausea. We can also look for indicators that a woman is at greater risk of having endometriosis, including if she’s in her 30s and 40s; has a close relative who has been diagnosed with endometriosis (which increases risk by five to seven times); and has a higher body mass index (which is thought to promote the development of endometriosis because fat increases estrogen levels).

Raising awareness about endometriosis and increasing its timely diagnosis improves women’s lives. While symptoms may range in terms of severity, nearly all of them take a physical toll on a woman’s day-to-day life—from increasing tiredness to limiting her physical capabilities. It’s time to talk with our patients more regularly about endometriosis, and ensure more women are getting the care and support they need.

OB-GYN’s Crucial Role in Protecting Women from Cervical Cancer

Every year, more than 12,000 American women are diagnosed with cervical cancer, and more than 4,000 of those women die from the disease. And, according to a reevaluation of existing data in a study recently published in the journal Cancer, the cervical cancer death rate may actually be much higher than previously estimated. Since January is Cervical Cancer Awareness Month, now is an excellent time to educate our patients about the steps they can take to not become a part of these terrible statistics.

We know Pap smears are one of the most effective tools we have to improve cervical cancer outcomes. Half of all cases of cervical cancer occur in women between the ages of 35 and 55; it’s rarely found in women under 20, and about 20 percent of cases are in women 65 and older. That’s why we recommend regular cervical cancer screenings in our patients starting at the age of 21 and through the age of 65 or longer based on individual risk factors. Pap smears screen for a cancer that’s often symptomless, and they help spot changes in the cervix before cancer develops—when treatments are most effective. Due to widespread adherence to Pap smear testing, deaths from cervical cancer have decreased by 50 percent over the last 30 years. So, encourage your patients to attend their annual well-woman visits. Along with the opportunity to offer Pap smears and screenings, these visits provide an ideal occasion to educate patients about cervical cancer risks and prevention.

Of course, virtually all cervical cancer cases are linked to HPV. HPV is the most common sexually transmitted infection: 80 percent of all sexually active people will contract the virus in their lifetimes. A family history of cervical cancer increases the risk two- to three-fold, since these women may have a genetically inherited condition that makes it harder for their bodies to fight off HPV infection. The three-dose HPV vaccine protects against 81 percent of cervical cancer cases. The CDC, AAP, AAFP and ACOG all recommend the vaccine for boys and girls between the ages of 11 to 12 years old. Full vaccination reduces risk of certain HPV-related cancer by up to 99 percent; boosting vaccination rates could prevent 29,000 HPV-related cases of cervical cancer every year.

Vaccine adherence rates, however, remain low, with only about one-third of girls and just over one in 10 boys receiving their full vaccination series. Educating your young patients or those who are parents of preteen children is important. Likewise, it’s important to ask your patients in their teens and 20s whether or not they’ve been vaccinated. Even if a patient missed the recommended vaccine as a child and is sexually active, if she’s under the age of 27, it may still be beneficial because there may not have been exposure to all of the virus strains the vaccine protects against. If a patient refuses vaccination at first, it never hurts to keep offering it at future visits.

Like many things we discuss with our patients, there is still a lot of misunderstanding about HPV and cervical cancer.  That’s why it’s so important to continue to encourage annual well woman visits and HPV vaccinations. For more information to help guide your conversations with patients, visit ACOG’s Immunization for Women website, shotbyshot.org, or the National Cervical Cancer Coalitions Cervical Cancer Awareness Month page.

“The greatest reward for doing is the opportunity to do more.”

Tom Gellhaus, MD ACOG's 67th President

Tom Gellhaus, MD
ACOG’s 67th President

“The greatest reward for doing is the opportunity to do more.” ~Jonas Salk

This past Tuesday I was awarded a great opportunity to do more: I became ACOG’s 67th President. As the nation’s leading group of physicians providing health care for women, we have an unprecedented opportunity to do more and be empowered to make a difference in health care.

When I began my presidency, I ventured that we can make a difference in the next generation of health care through three main initiatives: global health, advocacy and new resident education models.

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Guest Blog: Lady Ganga and the Fight to End Women’s Cancers

Larry Maxwell, MD, FACOG, COL(ret) U.S. Army, Director of the Globe-athon to End Women’s Cancers

Global statistics from the International Agency for Research on Cancer indicate that in 2012, gynecologic cancers accounted for 16% of the 6.6 million estimated new cases and 14% of the 3.5 million cancer related deaths among women. That means that 1 million women will be diagnosed this year with cancers below the belt and a woman will lose her battle with this disease almost every minute of every day. Cervical cancer accounted for 527,000 new cases and for 239,000 deaths. Although cervical cancer is the fourth-leading cause of cancer related death across the globe, it is the number one cause of cancer related deaths in some parts of Africa. Prevention of cervical cancer with the HPV vaccine is one of the best strategies to address the increasing problem of cervical cancer, particularly for low income countries. Unfortunately, only one third of eligible girls have received all 3 doses of the HPV vaccine in the U.S. This lack of compliance is increased among underserved groups such as African Americans. Public mistrust of the HPV vaccine has been fueled by information that is often misleading. The Vaccine Adverse Events Reporting System, a national database maintained by the CDC, has analyzed severe events and not found any causative relationships. In order to optimize public opinion and enhance compliance, it’s important to clarify additional misperceptions about the safety of the vaccine.

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Adults Need Vaccines, Too!

ACOG Celebrates National Immunization Awareness Month

Every year, thousands of adults in the United States suffer serious health problems, are hospitalized, or even die from diseases that could have been prevented by vaccination. To celebrate the importance of immunizations throughout life – and to help remind adults that they need vaccines, too – ACOG is recognizing August as National Immunization Awareness Month. This is the perfect opportunity to make sure adults are protected against diseases like whooping cough, tetanus, shingles and pneumococcal disease. Let’s not forget the flu either, as flu season is right around the corner!

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For the Times They Are A-Changin’

Come gather ’round people…  

…If your time to you’s worth savin’  

Then you better start swimmin’ or you’ll sink like a stone  

For the times they are a-changin’ ~Bob Dylan

I began my ACOG Presidency this past Wednesday by reciting some of Bob Dylan’s famous verse from the 1960’s. It rings true today, especially in medicine and our specialty as obstetrician-gynecologists.

As the times change I thank our now past-president, Dr. John Jennings, for his leadership and friendship during this past year. With the counsel of his past president, Dr. Jeanne Conry, John tackled some of the very difficult issues facing our practices and our workforce. I will continue his fine work and advance it on behalf of our patients, our specialty and our organization, ACOG.

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Million Women March for Endometriosis—Making a Difference!

I am energized to have represented ACOG today at the first Million Women March for Endometriosis. ACOG is a proud co-sponsor of this important event to raise awareness of this debilitating and painful gynecologic condition.

It was an honor to have spent the day with dedicated physicians and most importantly, the women, girls, and their families and friends who are affected by endometriosis and were here to march on the National Mall today in Washington, DC.

Together, we CAN make a difference.

Dr. Conry behind the scenes at EndoMarch 2014 with Drs. Ceana (left) and Camran Nezhat, two of EndoMarch's sponsors.

Dr. Conry behind the scenes at EndoMarch 2014 with Drs. Ceana (left) and Camran Nezhat, two of EndoMarch’s sponsors.

Excited despite the cold! Dr. Conry with Linda C. Giudice, MD, PhD, Immediate Past President of the American Society for Reproductive Medicine, and Marc R. Laufer, MD, Chief, Division of Gynecology at Boston Children's Hospital.

Excited despite the cold! Dr. Conry with Linda C. Giudice, MD, PhD, Immediate Past President of the American Society for Reproductive Medicine, and Marc R. Laufer, MD, Chief, Division of Gynecology at Boston Children’s Hospital.

Community Walks Take Public Health Messages to the Streets

Last week, I walked one mile on my lunch hour. That may not seem like much exercise, but it certainly inspired me! Why? Because it was a community walk, in downtown Sacramento that started at the farmer’s market near our state capitol. Talk about messages on health—fresh food, fresh air, and exercise—this walk has it all. Each week, physician volunteers are invited to lead folks in a one-mile walk, answer questions, and reinforce health messages all in the shadow of our state capitol during lunch hour so that many state employees can participate. I know that I have pointed out that we are leaders in so many ways, and I really think this captures it. As physicians, we can lead in our hospitals, in our office practices, certainly through ACOG, but it is also great to look for community opportunities to get health messages out there.

Roughly 200 people attended our walk. They are my inspiration. I reminded them about the benefits of exercise: reducing their risk for heart disease, breast cancer, and colon cancer and feeling better in general. Then I gave them my favorite acronym on staying FIT:

Frequency: Exercise FIVE days a week
Intensity: Exercise so you cannot walk and talk at the same time (I call it “huffy-puffy”)
Timing: Exercise for at least 30 minutes

The setting at the farmer’s market is fun because there are opportunities to reinforce the importance of eating healthy fresh fruits and vegetables, reducing exposure to pesticides, and taking a half hour a day to devote to exercise. For those not ready for 30 minutes, I often try the “10 Minutes for Me” Challenge. I ask a nonexerciser to take 10 minutes every single day for 30 days and walk, saying “I have 10 minutes for me” so that they set his or her priorities differently. At the end of 30 days, these once-nonexercisers get the message that it is more about time than energy, and they add another 10 minutes of walking. The goal is to get a nonexerciser up to 30 minutes a day within three months!

Thankfully, the temperature has not yet hit 100 degrees (it was ONLY 95 on the day of our walk). But these walks do not have to be limited by weather. We all have mall walking programs nearby, and we can encourage participation in those. There are some well-known programs in Maryland and Virginia that have had regular participants for over 20 years. Those seniors are enough to inspire anyone.

So, lace up you shoes and get out into the community. No matter where you live, your words and actions can make a difference.

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A Rough and Tumble Time for Women in Texas

What a week! If you’ve been following the epic battle over abortion legislation in Texas like me, you may be feeling exhilarated and inspired by the developments there. What Texas women have done is remarkable. They’ve thrown a hand in the face of legislators who are trying to regulate what goes on behind closed doors, in the privacy of a doctor’s office, between a patient and her doctor. Women have made it known—loud and clear—how they feel about TRAP (Targeted Regulation of Abortion Providers) laws being passed on their turf, and the Texas Legislature couldn’t help but listen.

During this pivotal moment in time, we at ACOG raised our voices along with the women in Texas. We denounced these unnecessary bills, making it clear that scientific facts are important, that politicians should get out of our exam rooms, and reiterating what should be obvious: Women are fully capable of making important decisions about their own health and should be able to do so without interference from the government. As ob-gyns, it’s our job to inform and support these decisions.

We know that TRAP legislation is being considered in a number of other states. Unfortunately, this isn’t the first—or the last—attempt by politicians to confuse the conversation with inaccurate and misleading information and without regard for what women want. But it’s clear to me that women will continue to stand up for their reproductive rights. And we at ACOG will stand ready to respond with scientific facts, conviction, and common sense on behalf of the women we serve.

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A Major Victory for Women’s Health and Ob-Gyns at the AMA

As I’ve said many times, this is an amazing time for women in the US. And the news just keeps getting better: We now have a dedicated, life-long advocate for women’s health in line to lead one of the most influential medical organizations in the country.

I was thrilled this week to witness the election of Robert M. Wah, MD, as president-elect of the American Medical Association (AMA). The AMA sets national, cross-specialty guidelines for physician ethics and medical education standards, and it also serves as a thought leader and central voice for doctors in the US. As only the third ob-gyn to be elected as AMA president, I am confident that Dr. Wah will always keep the health and needs of women of all ages at the forefront. He is someone who understands both specialty care and primary care, physician and patient needs in surgical and outpatient settings, private and public health needs, and most importantly in my opinion, the role of women as the drivers of health care.

Dr. Wah is an ob-gyn from Northern Virginia with a string of accolades too long too list. He currently practices and teaches at the Walter Reed National Military Center in Bethesda, MD, and the National Institutes of Health. Prior to his election, he was active in many areas of the AMA and also has served on ACOG’s Executive Board and Health Care Commission.

ACOG lobbied for and wholeheartedly supports Dr. Wah’s election. We believe he will not only serve our specialty well, but all physicians, women, and their families, too. We’re excited in anticipation of the great changes he will inspire during his tenure.

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